Subscribe to RSS
DOI: 10.1055/a-1310-3583
RLC score (R status, lymphovascular invasion, C-reactive protein) predicts survival following radical cystectomy for muscle-invasive bladder cancer
Der RLC-Score (R-Status, Lymphgefäßinfiltration, CRP) zur Vorhersage des Gesamtüberlebens bei Patienten mit muskelinvasivem Harnblasenkarzinom nach radikaler Zystektomie![](https://www.thieme-connect.de/media/uro/202206/lookinside/thumbnails/0196_10-1055-a-1310-3583-1.jpg)
Abstract
Background CRP-based scoring systems were found to correlate with survival in patients with urooncologic diseases. Our retrospective single-centre study aimed to confirm CRP as a prognostic parameter in patients with bladder cancer (BCa) undergoing radical cystectomy (RC) and, based on the findings, to develop our own outcome score for muscle-invasive bladder cancer (MIBC) patients undergoing RC in order to identify patients with a high risk of mortality.
Material and methods A total of 254 patients who underwent RC at Hanover Medical School between 1996 and 2007 were reviewed with a follow-up until autumn 2013. The clinicopathologic parameters assessed included age, co-morbidities, pre-/postoperative serum levels of CRP, leukocytes, haemoglobin, creatinine, urinary diversion, tumour grading, staging, lymph node status, lymph node density (LND), lymphovascular invasion (LVI), metastases, and resection margin status. The Chi-square test was used for univariate analyses. Kaplan-Meier estimates and the log-rank test were used for survival analyses. Regarding outcome, overall survival (OS) was assessed.
Results The multivariate analysis excluding lymph node (LN)-positive and metastatic patients at time of RC showed a significant association of R status (R; p < 0.001), LVI (L; p = 0.021) and preoperative CRP level > 5 mg/l (C; p = 0.008) with OS. Based on these parameters, the RLC score was developed. The median OS in the intermediate, high-risk and very high-risk groups according to the RLC score was 62, 22, and 6.5 months, respectively. The score had a high predictive accuracy of 0.752.
Conclusion The RLC score identifies BCa patients at a higher risk of overall mortality after RC. Overall, our study supports the role of CRP in prognostic score models for BCa.
Zusammenfassung
Hintergrund In der Vergangenheit konnte für CRP basierte Klassifizierungssysteme bereits eine Korrelation mit dem Überleben bei Patienten mit uroonkologischer Erkrankung nachgewiesen werden. Unsere retrospektive, unizentrische Studie zielte darauf ab, CRP als prognostischen Parameter für Patienten mit Harnblasenkarzinom (BCa), die sich einer radikalen Zystektomie (RC) unterziehen, zu bestätigen und basierend auf diesen Beobachtungen ein eigenes Klassifizierungssystem für muskelinvasive Harnbasenkarzinome zu entwickeln, welches Patienten mit einem hohen Mortalitätsrisiko sicher identifizieren kann.
Material und Methoden Insgesamt wurden Daten von 254 Patienten der Medizinischen Hochschule Hannover, die sich zwischen 1996 und 2007 einer RC unterzogen und bis Herbst 2013 nachbeobachtet wurden, ausgewertet. Die ausgewerteten klinisch-pathologischen Parameter umfassten u. a. das Alter, Komorbiditäten, prä- und postoperative CRP-Spiegel, Tumorgrading und -staging, Lymphknotenstatus, die lymphovaskuläre Infiltration (LVI) sowie Metastasenstatus und Resektionsränder (R-Status). Univariate Analysen wurden mittels Chi-Quadrat-Test durchgeführt. Ausgewertet wurde das Gesamtüberleben (OS).
Ergebnisse Die multivariate Analyse unter Ausschluss Lymphknoten positiver und metastasierter Patienten ergab eine signifikante Korrelation von R-Status (R; p < 0,001), LVI (L; p = 0.021) und präoperativ eleviertem CRP-Spiegel > 5 mg/l (C; p = 0,008) mit dem OS. Das mediane OS in den RLC-Risikogruppen betrug 62 Monate in der mittleren Risikogruppe, 22 Monate in der Hochrisikogruppe und 6,5 Monate in der Gruppe mit sehr hohem Risiko. Der Score hatte eine hohe Vorhersagegenauigkeit von 0,752.
Schlussfolgerung Der RLC-Score identifiziert BCa-Patienten nach RC mit einem höheren Risiko für eine erhöhte Mortalität. Insgesamt stützen unsere Daten die Rolle von CRP in prognostischen Vorhersagemodellen beim BCa.
Keywords
bladder cancer - C-reactive protein - survival score - radical cystectomy - overall survivalSchlüsselwörter
Harnblasenkarzinom - C-reaktives Protein - Überlebensscore - radikale Zystektomie - Gesamtüberleben* Joint first authors
Publication History
Article published online:
14 January 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68: 7-30 DOI: 10.3322/caac.21442.
- 2 Babjuk M, Bohle A, Burger M. et al. EAU Guidelines on Non-Muscle-invasive Urothelial Carcinoma of the Bladder: Update 2016. Eur Urol 2017; 71: 447-461 DOI: 10.1016/j.eururo.2016.05.041.
- 3 European Organisation for Research and Treatment of Cancer. EORTC risk calculator 2016. Available from: http://www.eortc.be/tools/bladdercalculator/
- 4 Gakis G, Todenhofer T, Renninger M. et al. Development of a new outcome prediction model in carcinoma invading the bladder based on preoperative serum C-reactive protein and standard pathological risk factors: the TNR-C score. BJU Int 2011; 108: 1800-1805 DOI: 10.1111/j.1464-410X.2011.10234.x.
- 5 Zhou L, Cai X, Liu Q. et al. Prognostic Role of C-Reactive Protein In Urological Cancers: A Meta-Analysis. Sci Rep 2015; 5: 12733 DOI: 10.1038/srep12733.
- 6 Saito K, Kihara K. C-reactive protein as a biomarker for urological cancers. Nat Rev Urol 2011; 8: 659-666 DOI: 10.1038/nrurol.2011.145.
- 7 Liu C, Li H. Correlation of the severity of chronic kidney disease with serum inflammation, osteoporosis and vitamin D deficiency. Exp Ther Med 2019; 17: 368-372 DOI: 10.3892/etm.2018.6916.
- 8 Iimura Y, Saito K, Fujii Y. et al. Development and external validation of a new outcome prediction model for patients with clear cell renal cell carcinoma treated with nephrectomy based on preoperative serum C-reactive protein and TNM classification: the TNM-C score. J Urol 2009; 181: 1004-1012 , discussion 1012. DOI: 10.1016/j.juro.2008.10.156.
- 9 Lasko TA, Bhagwat JG, Zou KH. et al. The use of receiver operating characteristic curves in biomedical informatics. J Biomed Inform 2005; 38: 404-415 DOI: 10.1016/j.jbi.2005.02.008.
- 10 Yoshida S, Saito K, Koga F. et al. C-reactive protein level predicts prognosis in patients with muscle-invasive bladder cancer treated with chemoradiotherapy. BJU Int 2008; 101: 978-981 DOI: 10.1111/j.1464-410X.2007.07408.x.
- 11 Kamat AM, Hahn NM, Efstathiou JA. et al. Bladder cancer. Lancet 2016; 388: 2796-2810 DOI: 10.1016/S0140-6736(16)30512-8.
- 12 Stein JP, Lieskovsky G, Cote R. et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001; 19: 666-675 DOI: 10.1200/JCO.2001.19.3.666.
- 13 Shariat SF, Karakiewicz PI, Palapattu GS. et al. Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium. J Urol 2006; 176: 2414-2422 discussion 2422 DOI: 10.1016/j.juro.2006.08.004.
- 14 Grossman HB, Natale RB, Tangen CM. et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 2003; 349: 859-866 DOI: 10.1056/NEJMoa022148.
- 15 Jager W, Thomas C, Haag S. et al. Early vs delayed radical cystectomy for 'high-risk' carcinoma not invading bladder muscle: delay of cystectomy reduces cancer-specific survival. BJU Int 2011; 108: E284-288 DOI: 10.1111/j.1464-410X.2010.09980.x.
- 16 Heck MM, Retz M, Nawroth R. Molecular lymph node staging in prostate and bladder cancer. Urologe A 2014; 53: 484-490 DOI: 10.1007/s00120-014-3441-4.
- 17 Leow JJ, Martin-Doyle W, Rajagopal PS. et al. Adjuvant chemotherapy for invasive bladder cancer: a 2013 updated systematic review and meta-analysis of randomized trials. Eur Urol 2014; 66: 42-54 DOI: 10.1016/j.eururo.2013.08.033.
- 18 Advanced Bladder Cancer Meta-analysis C. Adjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis of individual patient data Advanced Bladder Cancer (ABC) Meta-analysis Collaboration. Eur Urol 2005; 48: 189-199 discussion 199-201 DOI: 10.1016/j.eururo.2005.04.005.
- 19 Shrotriya S, Walsh D, Bennani-Baiti N. et al. C-Reactive Protein Is an Important Biomarker for Prognosis Tumor Recurrence and Treatment Response in Adult Solid Tumors: A Systematic Review. PLoS One 2015; 10: e0143080 DOI: 10.1371/journal.pone.0143080.
- 20 Shrotriya S, Walsh D, Nowacki AS. et al. Serum C-reactive protein is an important and powerful prognostic biomarker in most adult solid tumors. PLoS One 2018; 13: e0202555 DOI: 10.1371/journal.pone.0202555.
- 21 Kramer MW, Heinisch A, Wegener G. et al. C-reactive protein prior to radical cystectomy: preoperative determination of CRP. Urologe A 2014; 53: 222-227 DOI: 10.1007/s00120-013-3299-x.
- 22 Grimm T, Buchner A, Schneevoigt B. et al. Impact of preoperative hemoglobin and CRP levels on cancer-specific survival in patients undergoing radical cystectomy for transitional cell carcinoma of the bladder: results of a single-center study. World J Urol 2016; 34: 703-708 DOI: 10.1007/s00345-015-1680-7.
- 23 Game X, Soulie M, Seguin P. et al. Radical cystectomy in patients older than 75 years: assessment of morbidity and mortality. Eur Urol 2001; 39: 525-529 DOI: 10.1159/000052498.
- 24 Clark PE, Stein JP, Groshen SG. et al. Radical cystectomy in the elderly: comparison of clincal outcomes between younger and older patients. Cancer 2005; 104: 36-43 DOI: 10.1002/cncr.21126.
- 25 May M, Fuhrer S, Braun KP. et al. Results from three municipal hospitals regarding radical cystectomy on elderly patients. Int Braz J Urol 2007; 33: 764-773 , discussion 774-766